Thursday, 3 February 2011

Elderly Care Reform Or Balancing the Books?

The Scottish government is proposing moving approximately 38,000 council workers to the NHS under a radical plan to look after the elderly.

Under the government's plans Shona Robison, Health Minister, said older people could get better treatment with more integrated services. The NHS would take charge of organising home care for patients who need support after leaving hospital. It's also hoped the proposals, to be taken forward by a 'lead commissioning' group with £2m of backing, would save money and cut bed blocking.

"We want to see health and social care for adults delivered in an integrated way by NHS and council social work staff working together to give a seamless service.

"Evidence from partnerships in England shows more older people can get quicker care packages, cuts in delayed discharges, reduced length of stay in acute hospitals and fewer unplanned emergency admissions to hospital".

Let me get this right. Currently some social workers are seconded from the local council to the relevant health board where they assist with problems, such as organising home care or care home places, concerning the hospitalised elderly. What is proposed is that these council staff will now be transferred onto the health board's books. The council will then become 'lead commissioners'.

So all social work services for the elderly will no longer be provided by local authorities. I presume local councils will continue to provide services for those who require home care or is this to be provided by the NHS?

Will the NHS be providing occupational therapy and such other services for those who have been discharged from hospital or will such services then be transferred back to local authorities? As a means of saving money this sounds a non-starter if it is partly duplicating services currently provided by local councils.

It would appear to be an attempt to solve the problems created by handing the care of frail patients backwards and forwards between councils and the health service. But will it? The NHS isn't any better than councils for making speedy decisions and I wonder if this change will improve the service for elderly patients.

The Herald also has some questions although welcomes the proposals in principle. However, the affable Cosla president, Pat Watters, launched a strong attack on the plans, saying that during four years of debating the issue with the minister she had 'at no time raised this idea as the best way forward'.

The government do have Lord Sutherland, who reviewed Scotland's landmark free care for the elderly scheme, on side. "The time for talking is over. It is now time just to get on with it."

I think the time for talking is only beginning. The public need to understand the implications of this plan and I'm already confused. Presently any frail person needing assistance with care contacts their local council. Will this change once these proposals are brought into practice in 2013? Is this proposal partly to redeploy local authority staff and save jobs? I'm strongly in favour of jobs being saved but would be less happy if moving these workers to the already top-heavy administration of the NHS proved to be only a process to balance the books.

I suppose the devil will be in the detail of the proposal and once the Scottish government puts it online then we can all read what the future holds.

Have a look at the position in Orkney where the Council and the Health Board have set up a joint body to manage the delivery of adult care under a single management. Basically all OIC's adult services are transferred along with the equivalent NHS staff to give anintegrated service. Home care is there along with occupational therapy and mental health which have long been joint services. It's likely not perfect but it's worth your looking to see what like integration can be.

The principle of keeping health care public is to be welcomed RA and I'm sure it is.

What I can't understand about this is why it's happening. It won't save money and I can't see it being more efficient. Social workers are already seconded to hospitals. Are they going to be more efficient being on the NHS payroll? There's something not quite fitting the spin here.

SR. Can't access that story as I have to register. It must be The Herald preparing for a paywall or something.I get the latest Labour news from the BBC so don't read The Scotsman or Herald these days anyway.